Migraine is a neurological disorder that causes moderate-to-severe headaches. The pain often affects one side of the head, but can affect both. It is generally associated with nausea, light sensitivity and sound sensitivity. Other symptoms may include dizziness, vomiting, and difficulty thinking. In some cases, a migraine attack begins with a period of sensory disturbance known as an aura. Some people experience occasional migraine attacks, while others develop chronic migraine with frequent headaches. Migraine frequency can increase over time. In some cases, frequent use of pain medications can make migraines worse and lead to medication overuse headache. Attacks are more likely to happen when changes occur in a person's daily routine. These triggers can include lack of sleep, disrupted sleep, skipped meals, and hormonal fluctuations. Migraine is believed to result from a combination of genetic, environmental, and neurological factors that affect the activity of nerve cells and chemical signals in the brain. Migraine attacks are theorized to occur when the brain exceeds an individual's sensitivity threshold. Migraine attacks have multiple phases. The initial phase of a migraine attack can start 48 hours before the main headache phase and may cause early warning symptoms. The subsequent pain phase of a migraine attack may be linked to increased activity in the pain pathway of the brain, with heightened blood flow and transmission of pain signals. Managing migraine includes lifestyle changes to identify and manage possible triggers, and can include stress management, improving sleep habits, eating regularly, and exercising. Treatment for acute mild to moderate attacks begins with over-the-counter pain relievers such as ibuprofen and paracetamol. Triptans are recommended as a first-line therapy for moderate to severe attacks. Gepants are also effective, and are used when triptans are ineffective or not suitable. Anti-nausea medications are used for migraine-related nausea. Several medications can help prevent migraines. Preventive medications include gepants, but also beta blockers, anticonvulsants and certain antidepressants. Opioids should not often be prescribed for migraine. Approximately 14% (1.16 billion) of people worldwide are affected by migraine, making it the third-most disabling condition affecting the nervous system and one of the most common causes of disability. Women experience more and longer migraines than men do, and higher disability related to migraines, beginning in puberty. Migraines often start occurring after the first menstrual period, increasing in frequency over time, peaking during perimenopause, and tending to decrease following menopause. From age 30 to 50, up to four times as many women experience migraine attacks as men.
Signs and symptoms Migraines typically present as recurrent, mostly one-sided, pulsating headaches, along with heightened sensitivity to light, sound, and other sensory stimuli. The severity of pain, duration of the headache, and frequency of attacks vary. Symptoms may last for hours or days, seriously affecting quality of life. Migraine attacks can be described in terms of four stages or phases, which may not all be experienced.
The premonitory phase or prodrome, generally defined as the 48 hours preceding the pain phase. Aura, reversible neurological disturbances (often visual) lasting 5–60 min, generally near onset of the pain phase. These auras are reported by about 30% of migraineurs. The pain phase, also known as the headache phase. The postdrome, effects following the end of the pain phase of an attack. About 30% of people living with migraine experience episodes with aura. Women are more likely than men to experience migraine without aura. A migraine attack lasting longer than 72 hours despite treatment is known as status migrainosus. This condition can lead to complications like dehydration due to vomiting or lack of oral fluid intake, and interfere with the taking of oral medication. Patients may require emergency room or hospital-level care. Migraine is associated with neuropsychiatric disorders including major depression, bipolar disorder, anxiety disorders, obsessive–compulsive disorder, and sleep disorders. Shared neurobiological mechanisms may underlie multiple conditions. Co-occurrence of depression seems higher among those who experience aura compared to individuals who do not.
Prodrome phase The prodrome, or premonitory phase, of migraine is generally defined as the 48 hours preceding the pain or aura phases of an attack. Estimates of how often prodromal symptoms occur vary widely. Around 29% of people with migraine in population-based studies report at least one premonitory symptom. Amongst individuals who attend headache clinics, around 66% of people report premonitory symptoms. Symptoms may vary widely, and can include altered mood, irritability, depression or euphoria, fatigue, craving for certain food(s), difficulty speaking or reading, yawning, stiff muscles (especially in the neck), constipation or diarrhea, and sensitivity to smells or noise. Premonitory symptoms may occur in both migraine without aura and migraine with aura.
Aura phase
Aura is a 5–60 minute neurological event that generally occurs just before the onset of the headache. Symptoms can be visual, sensory, or motor in nature. Visual effects occur most frequently, in as many as 99% of cases involving aura. In rare cases known as persistent aura, aura symptoms may remain after 60 minutes. Visual disturbances often consist of a scintillating scotoma or flickering in someone's field of vision that may interfere with their ability to read or drive. This typically starts near the center of vision and then spreads out to the sides with jagged or zigzagging lines. Lines are usually black and white, but may also appear colored. Some people lose part of their field of vision, while others experience blurring. Sensory auras are the second most common type of aura; they occur in 30–40% of people with auras. A feeling of pins-and-needles may begin on one side in the hand and arm and spread to the nose and mouth area on the same side. Numbness usually occurs after the tingling has passed, with a loss of position sense. Other symptoms of the aura phase can include speech or language disturbances, world spinning, and, less commonly, motor problems. Motor symptoms indicate a hemiplegic migraine, and weakness often lasts longer than one hour unlike other auras.
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